ADHD: A Social Disorder?

ADHD: A Social Disorder?

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects many aspects of an individual’s life, including social interactions and relationships. In my experience treating adults with ADHD, one of the most common reasons patients seek treatment is due to their interpersonal struggles. These struggles can range from difficulties with spouses, bosses, friends, and co-workers. Often, it is one of these associates that prompts the patient to seek treatment for the ADHD symptoms that are negatively affecting their relationships.

Research supports the observation that adults with ADHD face significant challenges in their romantic relationships. Studies have shown that adults with ADHD have fewer and shorter romantic relationships, lower marital satisfaction, greater relationship maladjustment, and higher rates of divorce than adults without ADHD (Eakin et al., 2004; J. J. S. Kooij, 2018; Minde et al., 2003; Murphy & Barkley, 1996). Importantly, these impairments in romantic relationships appear to persist as individuals age. In a sample of participants aged 60 to 94, adults with ADHD were three times more likely than non-ADHD controls to have never married or to be divorced (Michielsen et al., 2015).

The impact of ADHD on peer relationships in adulthood is also widespread. Adults with ADHD tend to have worse social skills, significantly greater friendship problems, greater difficulty interacting with members of the opposite sex, and generally experience more loneliness compared to their non-ADHD counterparts (Harpin et al., 2016; McKee, 2017; Stickley et al., 2017). These difficulties can be attributed to the core symptoms of ADHD, which include inattention, hyperactivity, and impulsivity. These symptoms can interfere with the ability to engage in and maintain social relationships effectively.

An interesting study conducted in 2005 at the University of North Carolina Greensboro provides further insight into the social challenges faced by individuals with ADHD. In this study, an actress with a background in professional theater, who was also a doctoral student in clinical psychology, was employed to produce videotape segments in which she responded to a series of questions in a manner consistent with someone with ADHD, depression, anxiety, social phobias, or no mental disorder. These videos were then viewed by a random group of 130 undergraduate students. The students were given a number of validated surveys to complete based on their perception of the actress depending on which mood disorder she was demonstrating on the videotape. The results of the survey showed that the observers expressed significantly higher levels of hostility and social rejection toward the videos in which the actress demonstrated typical ADHD behaviors. This study helps explain why patients with ADHD typically struggle in making and maintaining long-term platonic and romantic relationships with others.

While the exact cause of this trend of social rejection towards adults with ADHD behaviors is not fully known, it is likely due to the fact that most adults with ADHD struggle with executive function deficits. Executive function is a set of mental skills that help individuals control and coordinate behaviors for long-term goals. For example, executive functioning is what allows us to “bite our tongue” when having a heated discussion with a friend, co-worker, employer, or spouse. When executive functioning is impaired in ADHD, an individual is more likely to disregard important social cues, speak over others during conversations, and make inappropriate comments during interactions. These behaviors can be off-putting to others and can lead to social rejection and isolation.

The impact of ADHD extends beyond friendships and romantic partnerships. It also affects parenting. Research has shown that mothers with greater ADHD symptomatology rate lower on parenting efficacy, involvement, and control, and higher on parenting dissatisfaction, laxness, and over-reactivity, relative to mothers without ADHD (Banks et al., 2008; Chronis-Tuscano et al., 2008). These mothers also self-report lower levels of involvement and positive parenting, as well as inconsistent discipline. Unfortunately, these perceived deficits in parenting due to ADHD symptoms have been shown to have negative downstream effects on children. A study published by Griggs and Mikami in 2011 showed that mothers’ inattentive and hyperactivity/impulsivity symptoms each significantly contributed to greater social impairment in their children.

ADHD’s impact on social relationships is multifaceted. The symptoms of ADHD—such as inattention, impulsivity, and hyperactivity—can directly interfere with an individual's ability to form and maintain relationships. For instance, inattention can lead to missed social cues and conversations, while impulsivity can result in interrupting others or making inappropriate comments. These behaviors can frustrate others and strain relationships. Additionally, hyperactivity can make it difficult for individuals with ADHD to engage in calm and sustained social interactions.

Executive function deficits are a core issue for individuals with ADHD. Executive functions are a set of cognitive processes that include working memory, flexible thinking, and self-control. These functions are crucial for planning, focusing attention, remembering instructions, and juggling multiple tasks successfully. When these functions are impaired, it can be challenging for individuals with ADHD to manage their behaviors and responses in social situations. For example, they may struggle with waiting their turn in conversations, controlling emotional outbursts, or adhering to social norms.

Social rejection and isolation are significant concerns for adults with ADHD. The behaviors associated with ADHD can lead to misunderstandings and misinterpretations by others. As a result, individuals with ADHD may find themselves excluded from social groups or activities. This exclusion can exacerbate feelings of loneliness and depression, creating a cycle of social withdrawal and increased ADHD symptoms. Moreover, the stigma associated with ADHD can further alienate individuals from their peers, making it even more difficult to establish and maintain social connections.

Effective management of ADHD symptoms is crucial for improving social relationships. Treatment options include medication, therapy, and lifestyle changes. Medications such as stimulants and non-stimulants can help manage the core symptoms of ADHD, making it easier for individuals to focus and control their impulses. Behavioral therapies, such as cognitive-behavioral therapy (CBT), can provide strategies for managing symptoms and improving social skills. Additionally, lifestyle changes like regular exercise, healthy eating, and sufficient sleep can have a positive impact on ADHD symptoms and overall well-being.

Support from family and friends is also essential. Educating loved ones about ADHD can help them understand the challenges faced by individuals with the disorder and provide the necessary support. Encouraging open communication and setting realistic expectations can help strengthen relationships. Support groups for individuals with ADHD and their families can offer a sense of community and shared experience, providing valuable resources and emotional support.

In conclusion, ADHD is a complex disorder that affects many aspects of life, particularly social relationships. Adults with ADHD often face significant challenges in their romantic and platonic relationships, as well as in parenting. These challenges are largely due to the core symptoms of ADHD and executive function deficits. Social rejection and isolation are common, but with effective management and support, individuals with ADHD can improve their social interactions and relationships. Understanding and addressing the social impact of ADHD is crucial for enhancing the quality of life for those affected by this disorder.

Citations

1. Eakin, L., Minde, K., Hechtman, L., Ochs, E., Krane, E., Bouffard, R., ... & Looper, K. (2004). The marital and family functioning of adults with ADHD and their spouses. Journal of Attention Disorders, 8(1), 1-10.
2. Kooij, J. J. S. (2018). Adult ADHD: Diagnostic assessment and treatment (3rd ed.). Springer.
3. Minde, K., Eakin, L., Hechtman, L., Ochs, E., Krane, E., Bouffard, R., ... & Looper, K. (2003). The psychosocial functioning of children and spouses of adults with ADHD. Journal of Attention Disorders, 7(1), 1-10.
4. Murphy, K. R., & Barkley, R. A. (1996). Attention deficit hyperactivity disorder adults: Comorbidities and adaptive impairments. Comprehensive Psychiatry, 37(6), 393-401.
5. Michielsen, M., Comijs, H. C., Semeijn, E. J., Beekman, A. T., Deeg, D. J., & Kooij, J. J. (2015). The relationship between ADHD and social dysfunctioning in old age. Journal of Attention Disorders, 19(5), 390-398.
6. Harpin, V., Mckee, M., & Hilton, D. (2016). The impact of ADHD on the life of an individual, their family, and community from preschool to adult life. Archives of Disease in Childhood, 101(9), 915-920.
7. Stickley, A., Koyanagi, A., Takahashi, H., Ruchkin, V., Inoue, Y., & Kamio, Y. (2017). Attention-deficit/hyperactivity disorder symptoms and loneliness: Findings from the adult psychiatric morbidity survey 2007. Psychiatry and Clinical Neurosciences, 71(9), 688-690.
8. Banks, T., Ninowski, J. E., Mash, E. J., & Semple, D. L. (2008). Parenting behavior and cognitions in a community sample of mothers with and without symptoms of attention-deficit/hyperactivity disorder. Journal of Child and Family Studies, 17(1), 28-43.
9. Chronis-Tuscano, A., Raggi, V. L., Clarke, T. L., Rooney, M. E., Diaz, Y., & Pian, J. (2008). Associations between maternal attention-deficit/hyperactivity disorder symptoms and parenting. Journal of Abnormal Child Psychology, 36(8), 1237-1250.
10. Griggs, M. S., & Mikami, A. Y. (2011). Parental influences on children with ADHD. Current Psychiatry Reports, 13(1), 44-50.

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